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Investigator II
Elevance HealthInvestigator II investigating healthcare fraud and conducting claim reviews across multiple health plans. Collaborating with law enforcement and assisting in policy development for preventive measures.
Posted 7/8/2026full-timeDenver • California, Colorado, Illinois, Minnesota, Tennessee, Washington, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $78,320 - $128,160 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare fraud investigation, including case development and coding review, while effectively collaborating with law enforcement and training stakeholders. Possesses strong knowledge of benefit program management and negotiation within the health insurance domain.
Highest-signal resume keywords
Healthcare Fraud InvestigationClaim ReviewFraud CertificationHealth Insurance ExperienceNegotiation Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case DevelopmentData MiningCoding ReviewEntity ReviewLaw Enforcement Referral
Soft Skills
Rapport BuildingTraining Ability
Certifications & Qualifications
CFEAHFIAAPC
Industry Keywords
Benefit Programs ManagementHealthcare InvestigationsFraud Detection
About the role
Key responsibilities & impact- Responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud
- Claim reviews for appropriate coding, data mining, entity review, law enforcement referral
- Responsible for identifying and developing enterprise-wide specific healthcare investigations
- Effectively establish rapport and on-going working relationship with law enforcement
- May assist in training of internal and external entities
Requirements
What you’ll need- Requires a BA/BS and minimum of 3 years related experience
- Fraud certification from CFE, AHFI, AAPC or coding certificates preferred
- Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred
- Health insurance, law enforcement experience preferred
Benefits
Comp & perks- Health insurance
- 401k contribution
- Paid Time Off
- Incentive and recognition programs
- Equity stock purchase